Intercity Lines Payment Authorization Form


Please fill out the fields & sign below if paying with a credit card. 

Intercitylines.com – 800-221-3936 – Info@intercitylines.com – P.O Box 1299 Warren, MA

Credit Card Payments can be made using a Visa or MasterCard. 
We do not accept American Express or other cards. We do not accept payment from 3rd parties. 

Name on Credit Card:    

Date: 

Phone Number:   

Email:   

Year, Make, & Model of the Vehicle being Transported:   

Pick Up City & State:   

Delivery City & State:   

Cost of Transport:   

Billing Address:   

For your security, we will call you for your credit card #. We typically run Credit Card payment’s once pick up has been scheduled 2-3 days before. 

I, the cardholder, authorize Intercity Lines, Inc to charge my Visa or Mastercard for payment of the vehicle transport described above. (PLEASE DO NOT PUT ANY PUNCTUATIONS IN YOUR LEGAL NAME. IT WILL NOT ALLOW YOU TO SIGN)

Leave this empty:

Signature Certificate
Document name: Intercity Lines Payment Authorization Form
Unique Document ID: 486d43331f1183b6b0182380713d9dc2d9398e05
TimestampAudit
October 26, 2018 11:28 am ESTIntercity Lines Payment Authorization Form Uploaded by NoReply IntercityLines - deanwilson@intercitylines.com IP 50.250.58.137, 185.93.229.11
March 22, 2019 11:40 am ESTICL inc - dean@Intercitylines.com added by Intercity Lines - dean@intercitylines.com as a CC'd Recipient Ip: 50.250.58.137
March 22, 2019 12:59 pm ESTICL inc - dean@Intercitylines.com added by Intercity Lines - deanwilson@intercitylines.com as a CC'd Recipient Ip: 50.250.58.137
March 22, 2019 1:11 pm ESTsharon S - sharon@intercitylines.com added by No Reply Intercity Lines - dean@intercitylines.com as a CC'd Recipient Ip: 50.250.58.137
March 22, 2019 1:11 pm ESTdean w - dean@intercitylines.com added by No Reply Intercity Lines - dean@intercitylines.com as a CC'd Recipient Ip: 50.250.58.137
March 22, 2019 1:14 pm ESTsharon S - sharon@intercitylines.com added by No Reply Intercity Lines - deanwilson012@gmail.com as a CC'd Recipient Ip: 50.250.58.137
March 22, 2019 1:14 pm ESTdean w - dean@intercitylines.com added by No Reply Intercity Lines - deanwilson012@gmail.com as a CC'd Recipient Ip: 50.250.58.137
August 12, 2019 2:51 pm ESTsharon intercity - sharon@intercitylines.com added by NoReply IntercityLines - deanwilson@intercitylines.com as a CC'd Recipient Ip: 50.250.58.137, 185.93.229.11
August 22, 2019 9:46 am ESTsharon intercity - sharon@intercitylines.com added by NoReply IntercityLines - deanwilson@intercitylines.com as a CC'd Recipient Ip: 50.250.58.137, 185.93.229.11